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Резекции центральных сегментов печени у детей

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Цель. Анализ ближайших результатов резекций центральных сегментов печени у детей на основании начального опыта. Материал и методы. Анализировали данные пациентов с различными центрально расположенными новообразованиями печени. В настоящее ретроспективное исследование включены 3 пациента с гепатобластомой, 1 наблюдение мезенхимальной гамартомы печени и 1 пациент с гепатоцеллюлярным раком. За период с марта по октябрь 2018 г. этим пациентам выполнены различные виды центральной резекции печени. Представлены технические аспекты, а также ближайшие результаты лечения. Результаты. Медиана возраста пациентов составила 78 мес (9 мес - 12 лет). Выполнили сегментэктомию 4b, бисегментэктомию 4b, 5, трисегментэктомию 4-6, мезогепатэктомию (анатомическую сегментэктомию 4, 5, 8) с реконструкцией желчеотведения от задних сегментов печени, мезогепатэктомию с анатомической резекцией S6 и атипичной резекцией S2, 3. Послеоперационные осложнения класса (степени) IIIа по Dindo- Clavien развились у 1 пациента. Сосудистых осложнений и печеночной недостаточности не было. Продолжительность госпитализации варьировала от 9 до 14 дней. Медиана наблюдения составляет 8 мес (7-14 мес). Общая и безрецидивная выживаемость на момент написания работы составляет 100%. Заключение. Резекция центральных сегментов печени у детей осуществима; операции следует выполнять в центрах, имеющих опыт хирургии печени.

Ключевые слова:
печень, опухоли, дети, центральная резекция, мезогепатэктомия, liver, tumors, children, central resection, mesohepatectomy

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Central segments liver resection for pediatric tumors

Aim. To analyze the short-term outcomes of сentral segments liver resection in children, according to the initial experience. Мethods. The data of patients with different centrally located liver neoplasms were analyzed. This retrospective study included three patients with hepatoblastoma, one observation of mesenchymal hamartoma of the liver and one patient with hepatocellular carcinoma. Different types of central liver resections were carried out in these patients between March and October 2018. The technical aspects and the short-term results are described. Results. Median age of patients was 78 months (9 months - 12 years). Patients underwent: segmentectomy 4b, bisegmentectomy 4b, 5, threesegmentectomy 4, 5, 6, mesohepatectomy (anatomical segmentectomy 4, 5, 8) with biliary reconstruction for posterior liver segments, mesohepatectomy with anatomical segmentectomy 6 and atypical S2, 3 resection. Dindo-Clavien grade IIIa postoperative complication developed in one patient. Vascular complications and posthepatectomy liver failure were absent. The hospital stay ranged between 9 to 14 days. The median follow-up period came to 8 months (7-14 months). The overall and event free survival at the time of writing is 100%. Conclusion. Resections of central liver segments in children are feasible and should be carried out in experiences in liver surgery centers.

Keywords:
печень, опухоли, дети, центральная резекция, мезогепатэктомия, liver, tumors, children, central resection, mesohepatectomy